Department of Nutrition, Georgia State University, Atlanta, GA 30302, USA.
J. Willis Hurst Internal Medicine Residency Program, Emory University, Atlanta, GA 30322, USA.
Int J Mol Sci. 2021 Mar 25;22(7):3373. doi: 10.3390/ijms22073373.
Ischemia with no obstructive coronary artery disease (INOCA) is a common diagnosis with a higher prevalence in women compared to men. Despite the absence of obstructive coronary artery disease and no structural heart disease, INOCA is associated with major adverse cardiovascular outcomes as well a significant contributor to angina and related disability. A major feature of INOCA is coronary microvascular dysfunction (CMD), which can be detected by non-invasive imaging and invasive coronary physiology assessments in humans. CMD is associated with epicardial endothelial-dependent and -independent dysfunction, diffuse atherosclerosis, and left-ventricular hypertrophy, all of which lead to insufficient blood flow to the myocardium. Inflammatory and oxidative stress signaling, upregulation of the renin-angiotensin-aldosterone system and adrenergic receptor signaling are major drivers of CMD. Treatment of CMD centers around addressing cardiovascular risk factors; however, there are limited treatment options for those who do not respond to traditional anti-anginal therapies. In this review, we highlight the ability of berry-derived polyphenols to modulate those pathways. The evidence supports the need for future clinical trials to investigate the effectiveness of berries and their polyphenols in the treatment of CMD in INOCA patients.
无阻塞性冠状动脉疾病的缺血（INOCA）是一种常见的诊断，女性的患病率高于男性。尽管没有阻塞性冠状动脉疾病和结构性心脏病，但 INOCA 与主要不良心血管结局相关，也是导致心绞痛和相关残疾的主要原因。INOCA 的一个主要特征是冠状动脉微血管功能障碍（CMD），可以通过非侵入性成像和人类的有创冠状动脉生理学评估来检测。CMD 与心外膜内皮依赖性和非依赖性功能障碍、弥漫性动脉粥样硬化和左心室肥厚有关，所有这些都会导致心肌血流不足。炎症和氧化应激信号、肾素-血管紧张素-醛固酮系统和肾上腺素能受体信号的上调是 CMD 的主要驱动因素。CMD 的治疗集中在解决心血管危险因素上；然而，对于那些对传统抗心绞痛治疗无反应的患者，治疗选择有限。在这篇综述中，我们强调了浆果衍生多酚调节这些途径的能力。证据支持需要进行未来的临床试验，以研究浆果及其多酚在 INOCA 患者 CMD 治疗中的有效性。
